Citizen intervention in a religious ban on in-school HPV vaccine administration in Calgary, Canada
Introduction
Despite extensive vaccine research and testing justifying regulatory approval, vaccine administration can be impaired by non-health related concerns, including normative views of religious and other groups. In one Canadian city, elected school trustees succumbed to the pressure of non-elected persons to ban routine human papillomavirus vaccine (HPV) immunization in schools. Eventually, effective citizen action helped to overturn the vaccine ban.
Section snippets
Background
In July 2006, a quadrivalent HPV vaccine (HPV4, the Merck Canada Inc. product called “Gardasil”) received Health Canada approval for use in females aged 9 to 26 (NACI, 2012). In March 2007, the Canadian Federal Government announced a $300 million allocation for the national vaccination of girls (Colucci et al., 2008).
In Canada, health services and education fall within the jurisdiction of the provinces and territories (Constitution Act, 1867). Routine publicly funded immunization of school-age
Reaching out
These data prompted a citizens' campaign to encourage the Board to lift its HPV vaccine ban. Fig. 1 shows a timeline of events.
The citizens' campaign included numerous opinion pieces in the local newspaper (Davis et al., 2012, Guichon, 2010, Guichon, 2012, Guichon and Joffe, 2012, Guichon et al., 2009), a private presentation to the Board by three physicians in June 2011 (Mitchell, 2011a), and many subsequent letters by these physicians to the Board (Mitchell, 2011b, Mitchell, 2012a, Mitchell,
Absent voices and unusual messages
The ban apparently affected also senior provincial health administrators. The physician-head of the regional ethics service for AHS rejected an article for publication in Calgary hospitals, claiming that it “suffers from a lack of balance, a possible mis-understanding [sic] of the position of the Catholic Bishop and Boards, and from an inability to guide the reader in use of ethics arguments to consider various points of view on a challenging subject” (Wasylenko, 2009). The Calgary Herald
Vigorous campaigning
In response to the Board's refusal in May 2012 to meet with the chief oncologist, local citizens formed a not-for-profit called, “HPV Calgary”, which created a website (HPV Calgary, 2012) and on June 25, 2012 released all correspondence between the Board and the three physicians (Graveland, 2012). Citing a failure of democracy, HPV Calgary called for the vaccine ban to end with the school year, June 30, 2012. The Board Chair responded, “Nothing is on the horizon to change our mind” (Bell, 2012)
New allies
Former administrators of the Calgary Catholic School District took a stand. Mr. William Dever, former Chief Superintendent, 1992–1996, stated publicly that the local bishop was “mistaken” (Nolais, 2012b). Dr. Jeremy Simms, former Chief Superintendent, 1996–2007, wrote to the Alberta Catholic bishops and Alberta Catholic Boards of School Trustees (Simms, 2012):
Because school districts bear the name ‘Catholic’, bishops believe that they are entitled to use their authority to enlist our schools
Helping parents decide
On October 29, 2012, the University of Calgary Medical School Dean wrote to the Board Chair, offering to provide expert information for the benefit of parent councils (Meddings, 2012a). The Chair declined (Martin, 2012c) and the Dean responded (Meddings, 2012b),
[…] While I accept that it is your decision, I am shocked that an organization that represents education, learning and values the acquisition of new knowledge would reject the opportunity to acquire expert information from another
Opening the school doors
At its meeting November 28, 2012, the Board reported that 87% of parent councils (91/104) voted in favor of in-school HPV vaccine administration (Canadian Press, 2012). The trustees then spoke individually stressing loyalty to the local bishop. They voted to permit in-school vaccination and presumed to stipulate the manner in which AHS obtains consent for vaccination (CCSD Board, 2012b). The Board also permitted nurses to vaccinate students who “for whatever reason, did not receive the vaccine
Conclusion
Although the vaccine ban in Calgary's publicly funded Catholic schools was eventually rescinded, the normatively grounded ban and public debate persisted for over four years. It constituted an unfortunate and ill-informed barrier to full implementation of a publicly funded, in-school vaccine program. The ban delayed or hindered access to protection from potentially life-threatening and transmissible HPV infection for approximately 16,000 girls. In addition, some AHS leaders impeded the public
Conflict of interest statement
The authors, Juliet R. Guichon, Ian Mitchell and Patricia Buffler declare that there are no conflicts of interest. Art Caplan sits on a Food and Drug Administration-created data safety and monitoring board for which he receives compensation. The board oversees a study of inhalers for children made by four companies including Merck and Glaxo, Smith Kline. He is also a Board Member of the Centre for Vaccine Ethics and Policy, which receives industry-funding including from Merck. He does not
Acknowledgments
The authors are indebted to Eduardo Franco for his technical information and advice in the preparation of this paper, and to the following people (in particular) who provided technical information, health surveillance statistics, advice, or support during the attempt to overturn the vaccine ban: Eduardo Franco, Audrey Farrier, Rose Penlington, Bruno Masquillier, Charlene Lyndon, Greg Mckinnon, William G. Hughson, Zeev Rosberger, William A. Fisher, Susan Bornemisza, Joseph Arvay, Jon Meddings,
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